The use of ATLS in complex axillary artery trauma. Overcoming this challenge. Case report and literature review

Abstract

The trauma of the subclavian and axillary arteries is uncommon but potentially serious. Penetrating injuries by firearm bullet and stabing are their usual mechanism. The anatomical complexity makes these injuries challenging to treat. Strictly following the ATLS protocol is the primarily responsible for the good prognosis in the high mortality potential that are arterial trauma in that topography. Access to approach the axillary artery depends on the extent and location of the lesion. In most cases a supra and / or infraclavicular incision are sufficient for the proximal control of the bleeding, however proximal subclavian artery ligature may be required. This cases generally involves the surgical access by median sternotomy - injuries to the right - and anterolateral thoracotomy for left lesions. In this context, axillary artery injury is a challenging trauma. We report a unique case that received initial treatment according to the ATLS protocol with ligation of the axillary artery. This paper analyzes the trauma and surgical approach of a 23 years old male lodged injuried by firearm in the left infra-clavicular topography presenting hypovolemic shock. In pleural drainage was out of more than 2000 ml of blood by subjecting it to thoracotomy and axillary artery ligation. He was referred to tertiary care service and held revascularization with saphenous vein graft. The conduct of care Trauma by ATLS was performed correctly, with the rapid identification of serious injury with a high potential for morbidity and mortality and need to transfer that allowed revascularization of patients achieving an excellent prognosis with patient survival and limb function maintenance. Thus, the axillary artery injuries are severe, with high lethal potential and need a fast and well-planned treatment. The patient should receive initial treatment by ATLS protocol, receiving life suport mesuares for its stabilization and subsequent transfer to definitive treatment if necessary.